Forensic Psychology Group Dynamics

¶ … placement of children and youth within residential group treatment programs group treatment will be reviewed. As will be reflected within the literature review, while there has been little direct attention focused on the use of groups and group treatment within residential placement settings for children and adolescents, there are a number of factors associated with residential placement that may be significant and meaningful to future efforts to further examine group treatment, group dynamics and group living experiences within residential programs. Initially, an overview will be provided of current information available on the use of residential placement as a treatment modality for meeting the service needs of children and adolescents. This will be followed by a discussion of current perceptions regarding residential placement and the problems associated with it. Finally, an overview will be provided of ongoing policy, practice and research issues associated with residential group care.

Overview of the Current Status of Residential Placement

According to Whitaker (2000a), group care services provided for children within residential settings have been described as a component of the child welfare system within the U.S. Such services are designed to provide 24-hour care for a child in a residential facility designed as a therapeutic environment. Within this setting are integrated treatment services, educational services, and group living on the basis of an individual plan for each child who cannot be effectively helped in his or her own home, (or) with a substitute family (Whitaker, 2000a). As further delineated by Braziel (1996), residential treatment centers and community-based group homes most often represent the primary forms of group care offered under the auspices of residential placement. The settings in which such services are offered include community-based apartments, group homes, campus-based facilities, foster care homes and other self-contained facilities, including secure units. Within these settings, as noted by Braziel (1996), typically a range of service are offered and include counseling, education, recreation, health, nutrition, daily living experiences, independent living skills, reunification services, and aftercare/post placement services. There has been an increasing effort to improve the linkages between the child or adolescent in residential care with his/her family and community.

As described by Melton (1998), most often residential placement services are provided under public, voluntary nonprofit, and proprietary auspices, in child welfare, child mental health, and juvenile justice systems, often to the same populations of youths. According to Melton, the divisions existing between such services are largely based on arbitrary regulatory and payment structures rather than real differences in purpose, type of services, clientele, or source of referral. As explained by Whitaker (2000a), while the diversity that exists among such programs are minimal, the children and adolescents receiving services by residential placement programs tend to represent clients from all or most of the major children's service systems (i.e., child welfare, juvenile justice, mental health). Historically, efforts at limiting the use of residential care in one service system area (i.e., child welfare, juvenile justice, mental health) for the purposes of deinstitutionalization most often has been accompanied by an increase in residential placements in another area of the system (Whitaker, 2000a). Thus, as noted by Whitaker, there has been a growing awareness that there is need for the development of a cross-system perspective in relation to residential placement for children and adolescents.

As a review of the literature suggests, it is difficult to obtain accurate population estimates of those children and adolescents placed in residential care within the U.S. On the basis of more recent information, a national study commissioned by the U.S. Children's Bureau provides a total population estimate of approximately 500,000 children and adolescents in out-of-home care in the mid-1990s (USDHHS, 1997). As found within the report provided by the U.S. Department of Health and Human Services (USDHHS), the majority of those children and adolescents placed within residential care settings were served in family foster care arrangements in comparison to the approximate one-fourth of all children in out-of-home care who were served in residential group care facilities.

Melton (1998) suggested that such estimates represent an inaccurate accounting of the actual numbers of children and adolescents who are served in residential placement. As further explained by Melton, there is a "hidden sector" found within residential care most often represented by those children and adolescents who are placed within private psychiatric settings as well as those who are in the custody of the juvenile justice system and placed within residential group care settings. As noted by Whitaker (2000a), such findings help to emphasize the importance of the development of an accurate, comprehensive, national, up-to-date database for all children and youths in residential group care.

While children and youth who have been adjudicated within the juvenile justice system have been identified as a "hidden population" receiving residential group care services, information is available that helps to clarify the population estimates of this group. On the basis of information provided by Smith (1998), during the late 1960s and early 1970s, the Statistics Division of the National Criminal Justice Information and Statistics Service of the Law Enforcement Assistance Administration (LEAA), which later became the Bureau of Justice Statistics (BJS), and the Children's Bureau initiated a joint effort to develop and implement a means for obtaining information regarding the census of public juvenile facilities. The resulting census, known as the Children in Custody (CIC) census, included public facilities holding juveniles awaiting court action as well as those already adjudicated. As reported by Smith, while previous efforts to obtain statistical information on children and youth in the juvenile justice system focused only on reception or diagnostic centers, training schools, ranches, forestry camps and farms, the new census also allowed for collection of information on juveniles within detention centers and shelters, halfway houses, and group homes.

Using the information gathered from the CIC census series between 1971 and 1995, Smith (1998) reported that while the numbers of public and private juvenile facilities in the United States have been decreasing since 1987, there were more such facilities in 1995 than there were in 1975. As well, there was an increase in the number of private facilities as compared to public facilities, even though 58% to 63% of the juveniles in correctional facilities were held in public facilities. Reportedly, a smaller percentage were held in private facilities because the majority of private juvenile facilities are ranches, forestry camps, farms, halfway houses, and group homes that generally have smaller populations than the detention centers and training schools that make up the majority of the public juvenile facilities (Smith, 1998).

As reported by Smith (1998), the percentage of all detained juveniles held in detention centers increased steadily from 15% in 1975 to 23% in 1995. The percentage of all private facilities that are ranches, forestry camps, farms, halfway houses, and group homes has decreased from 90% in 1975 to 75% in 1995. Smith indicated that there were 74,270 juveniles in custody in the United States on June 30, 1975 and 107,637 on February 15, 1995, representing a 45% increase. According to Smith, the increase in the number of males held in custody in juvenile justice residential placements helps to largely explain the increase between 1975 and 1995.

As Smith documented, there were only 725 more females held in 1995 than in 1975, while there was an increase of 32,642 males held in juvenile facilities over this same period. Thus, as the data suggested, juvenile female residents decreased from 23% in 1975 to 17% in 1995.

As reported by Smith (1998), the average length of stay for juveniles discharged from long-term residential facilities has also decreased. Approximately two-thirds of the juveniles held in public facilities since 1983 were held in long-term facilities. The average length of stay for those juveniles discharged from public, long-term facilities decreased from a little more than six months in 1986 to a little less than four months in 1995 (Smith, 1998).

Smith (1998) identified other trends that may be significant in the group care of juveniles in residential placement within the juvenile justice system. One such trend is that minority juveniles make up an increasingly larger segment of all juveniles held in custody. As reported by Smith, in 1979, there were 13,752 African-American juveniles held in custody as compared to 43,268 in 1975, representing more than a threefold increase in 15 years. Similarly, in 1979, there were 4,395 Hispanic juveniles in juvenile justice residential programs as compared to 18,653 in 1995, representing a more than fourfold increase. As also reported by Smith, the proportion of African-Americans in juvenile facilities has grown from 28% in 1979 to 40% in 1995. During the same time period, for Hispanics, the proportion has grown from 9% to 17%. According to Smith, these proportions exceed the proportion of juveniles in the general population. In the case of African-American juveniles, Smith reported that the numbers in residential place greatly exceed the proportion of juveniles in the general population. As documented by Smith, Hispanic juveniles age 10 to 17 made up 8% of all juveniles in that age group in 1980 and 13% in 1995 while African-American juveniles made up 15% of the general juvenile population age 10 to 17 in 1980 and 1995.

Smith (1998) also documented another important trend in relation to juveniles in juvenile justice residential placement settings that has occurred since 1987. As reported by Smith, the proportion of youth held in juvenile facilities for violent offenses increased over the period from 1987 to 1995 for both males and females. Findings reported by Smith suggested that males were more likely than females to be in custody for violent offenses, ranging from 20% in 1987 to 31% in 1995, compared with 6% in 1987 to 13% in 1995 for females. From 1987 to 1995, males were consistently and increasingly more likely to be in custody for delinquent acts (including violent, property, alcohol/drug, and public order offenses and probation violations), 77% in 1987, 82% in 1991, and 83% in 1995. According to Smith, alternatively, females were most likely, but less so each year, to be held in juvenile residential programs for nondelinquent reasons, including status offenses, nonoffender actions, and voluntary admissions, with 62% in 1987, 61% in 1991, and 55% in 1995.

Furthermore, as explained by LeCroy and Ashford (1992), residential placement and treatment services have come to represent both an expensive as well as a common intervention for children and adolescents with serious behavioral and emotional disorders. While less costly than psychiatric hospitalization on a per diem basis, residential treatment proves to be more expensive because of extended stays (Burns & Friedman, 1990; LeCroy & Ashford, 1992). The average annual costs associated with residential treatment and placement services have been estimated to range between $50, 000 and $75, 000 per child. Thus, an increasing complaint most often voiced in relation to residential placement is that a large proportion of the limited funds allocated to the service needs of children and adolescents are potentially committed to supporting residential treatment for a few, with little money left for the development or funding of community-based services (Burns & Friedman, 1990). However, as explained by Handwerk, Friman, Mott and Stairs (1998), in spite of the fact that residential placement represents both a massive and an expensive treatment modality, little research has been conducted that documents the effectiveness of residential treatment for those children and adolescents who receive it.

Current Perceptions on Residential Placement

As suggested by Whitaker (2000a), in spite of the fact that residential placement has continued to be extensively used within professional fields serving children and adolescents, there has been a long-standing sense of distrust of residential programs. Whitaker explained that such views are deeply rooted in American culture and history, emerging from a basic distrust of institutions and their capacity to care for and nurture children. This distrust arose during the mid-19th century when reformers advocated for alternative placements for children and adolescents other than the large congregate child care institutions that existed at that time. The health conditions found in early institutions were found to be horrendous and efforts arose to rescue children from such conditions. As noted by Whitaker, this period in child welfare and services became known as the "placing-out" movement which served as the catalyst to the creation of new, sectarian child care institutions, many of them reflecting the fears of recently arrived immigrant and Catholic families who perceived such efforts as an attempt to deprive children of their cultural and religious birthright.

Similar concerns and advocacy efforts began to resurface in the mid-20th century when child and youth advocates began to once more strongly promote the need for the development of alternatives to residential placement. In 1975, Morris Fritz Mayer who was recognized as a leading advocate for high-quality residential programs used the term "pariah care" to describe the conditions of residential centers that currently existed (Morris, 1975 as cited in Whitaker, 2000). Mayer as well as others promoted increased recognition of society's marginalization and the stigmatization of acting-out youths and the group services designed to meet their needs. Similarly, Wolins (1974) was calling attention to the fact that most residential programs during that time period were no longer staffed by professionals who reportedly had become increasingly discouraged by the lack of effectiveness believed to be associated with such programs. As professionals left residential placements and approbations were steadily withdrew from such programming, as noted by Wolins, residential placements for children and adolescents began to increasingly deteriorate with little evidence of ongoing efforts to promote the investment necessary for innovative and effective treatment programming within residential care.

According to Whitaker (2000a), after the first White House Conference on Children occurred in 1909, there was growing agreement that children and youth in need of out-of-home placement should be served by the family foster care system rather than in residential and group care settings. There was also an emphasis on insuring that truly dependent children were placed in foster care rather than in residential placement. Whitaker noted that by the mid-20th century, less than 10% of children in group care settings fit the description of "true orphans" or dependent children, representing the fact that the greater proportion of those children considered to be dependent children were now being served in family foster care. This was a complete reversal from what had been occurring in child placement at the beginning of the century. According to Whitaker, the focus in relation to group care settings then shifted to one in which efforts were directed towards their development as specialized treatment programs for children with emotional disturbance and/or conduct problems, for whom family foster care was deemed insufficient or inappropriate.

Within the literature, it is possible to discern at least five specific historical and current perceptions regarding residential placement and group treatment for children and youth. The first perception is based on reports regarding the degree to which residential placement and group treatment represents a helpful treatment method. Early accounts of residential placement experiences (e.g., Polsky, 1965; Schur, 1973) suggested that children and adolescents received treatment that was negligent and/or abusive while in residential placement. Other reports suggested that there were incongruities between treatment prescribed in residential programs and treatment delivered (Jessness, Allison, McCormick, Wedge, & Young, 1975; Kazdin, 1985; Quay, 1977). Similarly, the National Academy of Sciences panel, commissioned to evaluate evidence on the efficacy of residential placement programs for juvenile offenders, concluded that most evaluation studies were of limited value because little treatment was delivered and the treatment that was delivered often had little resemblance to the treatment prescribed (Martin, Sechrest, & Redner, 1981; Sechrest, White, & Brown, 1979). Concerns regarding the helpfulness of residential placement were further fueled by court rulings that mandated the right to treatment after finding residential programs deficient in providing meaningful treatment services to children and youth (e.g., Donaldson vs. O'Connor, 1974).

Another area of concern evidenced within the literature is associated with the relationships of supervising adults and the children and adolescents they serve in residential placements. Such relationships have tended to be perceived as adversarial, servile, or colluding and were fostered by the early work found in Goffman's (1964) Asylums, Sykes's (1958) The Society of Captives, and Clemmer's (1940) The Prisoner Community. Each of these books helped to suggest and foster the belief that the treatment received from custodians in residential placement programs was nothing less than horrific and painful. Similarly, later works suggested that those children and adolescents who entered residential placement programs suffered from problems with authority and found themselves in worse shape upon release due to the lack of freedom they were subjected to while in care (e.g., Empey & Stafford, 1991). Overall, there was concern as to how children and adolescents in residential care faired in future relationships after their experiences with adults who readily and at times, harshly, enforced rules (e.g., Lundman, 1984; Polsky, 1965).

A third major concern that has been evidenced in relation to residential placement is that associated with the degree to which residential placement produces an inexorable sense of isolation from family and friends (e.g., Eisikovits & Guttman, 1988; Empey & Stafford, 1991; Kiesler, 1982). The all-encompassing nature of residential life, the presence of institutional barriers to outside contact, and first-hand as well as case descriptions of residential life have emphasized the isolation and disconnection that children and youth experience in relation to family and friends (e.g., D'Amato, 1969; Polsky, 1965; Schur, 1973; Trieschman & Whittaker, 1972; Trieschman, Whittaker, & Brendtro, 1969).

Finally, as evidenced within the literature, there has also been concern over the degree to which residential placement leads to a limitation of children and youth's development of a sense of personal of control. As suggested within the literature, isolated from and forced to live away from their homes, families, and friends, children and adolescents are at risk in terms of their own sense of control over life events and less prepared to handle the future challenges of living (e.g., Gold & Osgood, 1992; Sykes, 1958). The importance of this belief is underscored by research showing that reduced sense of control has a strong relationship to maladjustment within placement (Gold & Osgood, 1992; Martin & Osgood, 1987). As well, research has provided evidence that suggested that residential programs decrease intrinsic motivation to engage in the prosocial behaviors that such programs intend to promote (e.g., Lepper & Green, 1978). Although this concern is widely cited in criticisms of behaviorally oriented programs, there have been few tests of the applicability of this research beyond laboratory settings. Only by directly comparing youths in and out of placement can we determine whether external reinforcement actually interferes with their sense of control.

Even though residential placement programs have shown significant changes in the last 20 years, the early negative images associated with these programs continues to prevail. Some of the changes that reportedly have been made include movement away from the traditional training school format with mostly custodial shift-work staff to a smaller group-home format with a family-type atmosphere and trained staff who live with the youths (e.g., Lerman, 1975; Lundman, 1984). While these changes were intended to improve residential treatment as well as the prevailing negative images associated with residential programs, little evidence exists that suggests these changes have been effective.

Policy, Practice and Research Issues

As addressed by Whitaker (2000b), during the bulk of the latter half of the 20th providing treatment for those children and youth, who due to emotional disturbance and/or conduct problems. Whitaker explained that a number of policy and practice issues were raised in relation to group care settings and consisted of the following:

lack of clear-cut diagnostic indicators for determining whether a child should be in residential placement as opposed to a family-based alternative.

The perception that some service systems, if left to their own devices, would use residential placement too freely without first providing services to the child and family in their home and community.

The perception that residential placement is an intrusive and disempowering intervention, particularly with respect to families.

The absence of hard evidence for comparative treatment efficacy, particularly long-term treatment.

The potential for physical and psychological abuse and institutional neglect of children in group care with frequent exposes presented within the press.

The difficulty in identifying core components of residential treatment services and codifying them in commonly agreed upon treatment protocols.

The high cost of residential treatment services relative to the numbers of children served, which some argue retards the growth of more effective preventive, "front-end" services. (Whitaker, 2000b).

As explained by Whitaker (2000b), issues such as those identified above have been accompanied by the belief that group care essentially is unreformable. Thus, as noted by the author, for a period of at least 25-year, group care for serious inquiry. Whitaker explained that in the late 1980s, a major division of the American Psychological Association (APA) commissioned and then declined to publish a thoughtful, balanced, and substantive report on the state-of-the-art in residential treatment, presumably because it might in some way be seen as promoting residential placements. Another example provided by Whitaker of the reluctance to engage in research on group care was an attempt in the 1970s at a comprehensive census of children and youths in residential care which was greatly limited in its scope and dissemination in its second implementation in the early 1980s due to the lack of willingness of any single national agency to take leadership and responsibility in seeing the study through to adequate completion. Consequently, as noted by Whitaker, the results were never published by the original sponsoring agency. According to Whitaker, the U.S. Children's Bureau, with a long history for standard setting in services for children and youth, focused only minimal attention on group care services during the late 1970s and 1980s when, by contrast, an expansive network of regional and national centers was created around adoption services, child abuse and neglect, and in-home services.